Comparison of manual compression, Z-stitch, and suture-mediated vascular closure device techniques in dogs undergoing percutaneous transvenous intervention

INTRODUCTION/OBJECTIVES

Manual compression has been standard of care for maintaining hemostasis after percutaneous endovascular intervention, but can be time-consuming and associated with vascular complications. Alternative closure methods include the figure-of-eight suture (Z-stitch) and vascular closure device (VCD) techniques. We hypothesized that compared to manual compression, Z-stitch and VCD would significantly reduce time-to-hemostasis after transvenous access, and the proportion of dogs with vascular patency would not differ significantly among treatments.

ANIMALS

Forty-six client-owned dogs undergoing percutaneous transvenous interventional procedures.

MATERIALS AND METHODS

Dogs with vessel diameter <5 mm were randomized to undergo manual compression or Z-stitch, while those with vessel diameter ≥5 mm were randomized to undergo manual compression, Z-stitch, or VCD. Time-to-hemostasis, bleeding scores, presence of vascular patency one day and two to three months post-procedure, and complications were recorded. Data are presented as median (95% confidence interval).

RESULTS

In all 46 dogs, the right external jugular vein was used. Time-to-hemostasis was significantly shorter in the Z-stitch (2.1 [1.8-2.9] minutes) compared to VCD (8.6 [6.1-11.8] minutes; P<0.001) and manual compression (10.0 [10.0-20.0] minutes; P<0.001) groups. Time-to-hemostasis was significantly shorter in the VCD vs. manual compression (P=0.027) group. Bleeding scores were significantly greater at 5 and 10 min (P<0.001 and 0.013, respectively) in manual compression, compared to Z-stitch group. There was no difference in the proportion of dogs with vascular patency between groups (P=0.59).

CONCLUSIONS

Z-stitch and VCD are effective venous hemostasis methods after percutaneous transvenous intervention, with Z-stitch providing the most rapid time-to-hemostasis. Both Z-stitch and VCD techniques have low complication rates and effectively maintain vascular patency.

Concomitant feline immunodeficiency virus (FIV) and Mycoplasma haemofelis in a barn cat

A 5-year-old male barn cat was presented with lethargy and excessive bleeding following castration. The patient developed hemolytic anemia and diagnostic tests revealed infection with feline immunodeficiency virus and Mycoplasma haemofelis. This case serves as a reminder of the importance of testing for infectious diseases and educating owners on feline infectious disease prevention and management.

Simple, minimally invasive technique for ovariohysterectomy in the dog

A simple method of minimally invasive surgery for ovariohysterectomy in the dog, without the use of laparoscopic equipment, was trialled. Fifty-nine client owned dogs of different breeds admitted for elective ovariohysterectomy were entered into the study. The tip of the left uterine horn and ovary were pulled into a cranial midline portal with the aid of a spay hook. The ovarian pedicle and the tip of the uterine horn were ligated and the ovary was dissected. The uterine horn was pulled backwards from a second midline portal, just cranial of the pubic bone, until the cervix was visible. After ligation and dissection of the cervix, the right uterine horn was pulled from the cranial portal until the right ovary was visible and could also be dissected. All 59 dogs underwent the intended procedure (mean duration 59 minutes, range 30 to 88 minutes). No haemorrhaging occurred during surgery and no serious complications were reported during the postoperative period.

Standing enucleation in the horse: a report of 5 cases

Enucleation was performed in 5 horses under local anesthesia and sedation with the horse standing. Minimal hemorrhage occurred during the surgical procedure, and there were no other reported complications. Standing enucleation is a surgery that is safe to perform in horses.

Coagulation profiles in dogs with congenital portosystemic shunts before and after surgical attenuation

BACKGROUND

Serious postoperative hemorrhage has been reported in dogs after closure of congenital portosystemic shunts (CPS).

HYPOTHESIS

In dogs with portosystemic shunting, low coagulation factor activity is responsible for coagulopathy, which can cause complications after surgery.

ANIMALS

Thirty-four dogs with CPS and 39 healthy dogs.

METHODS

In a prospective study, coagulation times, platelet count, and the activity of 8 coagulation factors were measured in dogs before and after surgical shunt attenuation and in 31 healthy dogs. The effect of abdominal surgery on hemostasis was determined at ovariectomy in 8 healthy dogs.

RESULTS

Dogs with CPS had lower platelet counts, lower activity of factors II, V, VII, and X, and increased factor VIII and activated partial thromboplastin time (APTT) compared to healthy dogs. After surgical attenuation, dogs with CPS had decreased platelet counts and activity of factors I, II, V, VII, IX, X, and XI and a prolonged prothrombin time (PT). Ovariectomy resulted in decreased activity of factors VII and X. Six weeks after surgery, portosystemic shunting persisted in 9 of 30 dogs, with no improvement of hemostatic values. CPS dogs without shunting had improved coagulation times and increased activity of factors II, V, VII, and X.

CONCLUSIONS AND CLINICAL IMPORTANCE

Dogs with CPS have lower activity of clotting factors compared to healthy dogs, resulting in a prolonged APTT. Surgical attenuation of the shunt results in increased abnormalities in coagulation times and factors immediately after surgery. Hemostasis is normalized after complete recovery of shunting after attenuation, in contrast to dogs with persistent shunting.

Efficacy and Safety of Preoperative Etodolac and Butorphanol Administration in Dogs Undergoing Ovariohysterectomy

Eighteen dogs undergoing ovariohysterectomy were premedicated with etodolac, butorphanol, or their combination. Various parameters, such as blood pressure, isoflurane requirements, behavioral pain scores, plasma cortisol concentration, plasma glucose concentration, and mucosal bleeding time, were assessed. The integrated plasma cortisol values were significantly lower in the etodolac and etodolac with butorphanol groups. Dogs receiving etodolac and butorphanol had the lowest behavioral pain scores from extubation until the end of monitoring. Isoflurane concentration over time (area under the curve), buccal mucosal bleeding time, and indices of renal function were not significantly different among the treatment groups.

A dorsal approach for the removal of the nasal septum in the horse

OBJECTIVE

To describe and evaluate a technique involving a dorsal approach for the removal of the nasal septum in adult horses.

STUDY DESIGN

Retrospective clinical study.

ANIMALS

Four client-owned horses.

METHODS

Access for partial nasal septum resection was through a dorsal nasal bone flap. Septum resection was performed because of reduced airflow from septal deviation and/or thickening caused by traumatic insult or neoplasia. Preoperative clinical signs and diagnostic results were recorded. Intra- and postoperative complications were noted and follow-up information was obtained from telephone interviews of owners or by clinical examination.

RESULTS

The abnormal segment of the nasal septum was completely removed in all horses. A dorsal nasal bone flap approach provided excellent access to the septum and allowed immediate control of hemorrhage; blood transfusion was not needed. Cosmetic results were considered good to excellent by owners and horses returned to their previous level of work without perceived limitations associated with airway function.

CONCLUSIONS

Nasal septum resection by the dorsal approach permits good observation of the abnormal septum, and provides exposure that facilitates removal of nasal masses and reduction of depression fractures with minimal complications.

CLINICAL RELEVANCE

A dorsal nasal bone flap approach should be considered for horses that require nasal septum resection because it can be achieved with minimal hemorrhage, good cosmetic results, and return to function.

Use of an Ultrasonically Activated Scalpel for Splenectomy in 10 Dogs with Naturally Occurring Splenic Disease

OBJECTIVE

To evaluate the safety and efficacy of an ultrasonically activated scalpel for performing splenectomy, with minimal ligation, in dogs.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Dogs (10) with naturally occurring splenic disease.

METHODS

Between October 2003 and February 2004, splenectomy was performed using an ultrasonically activated scalpel and a double seal method, in 10 dogs with naturally occurring splenic disease. Time for splenectomy and number of ligatures required were recorded. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short-term survival were evaluated.

RESULTS

Mean operative time for splenectomy, exclusive of celiotomy and closure, was 18 minutes (range, 8-25 minutes). The mean number of ligatures needed to perform splenectomy was 1 (range, 0-2 ligatures). One dog hemorrhaged from the splenic vein after ultrasonic scalpel transection of a vessel >5-mm diameter and required a ligature. The ultrasonic scalpel was easy to use, with a minimal learning curve. None of the dogs had postoperative abdominal hemorrhage; 9 dogs were discharged and 1 dog was euthanatized because of septicemia.

CONCLUSION

Ultrasonic activated scalpel may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle in dogs with minimal need for vascular ligation.

CLINICAL RELEVANCE

Ultrasonic scalpels can be used to perform splenectomy in dogs with naturally occurring splenic disease.

Management of hemodynamic changes associated with removal of a large abdominal myofibroblastic tumor in a pony

A 22-year-old female Welsh-cross pony was evaluated because of intermittent colic, signs of depression, pyrexia, anorexia, muscle wasting with abdominal distention, and weight gain over the preceding 12 months. A large abdominal mass was detected and surgically removed; the hemodynamic alterations and complications caused by the dramatic fluid losses and shifts that can occur in association with removal of a large abdominal mass required extensive postoperative management. Monitoring of clinical and hematologic variables such as attitude, heart rate, mucous membrane color, mean arterial blood pressure, PCV, and plasma total protein concentration provided useful information for successful management of the patient after surgery. On removal, the tumor weighed 19% of the pony's body weight and was characterized as a myofibroblastic tumor. Myofibroblastic tumors should be considered as a differential for large internal abdominal masses in horses, and surgical removal may be feasible and life extending with appropriate postoperative care.

Successful ovariectomy in a dog with Glanzmann thrombasthenia

Ovariectomy was performed in a 7-month-old Great Pyrenees with a severe congenital bleeding disorder. A diagnosis of Glanzmann thrombasthenia, a rare, congenital bleeding disorder characterized by a functional platelet defect, was later confirmed by isolation of genomic DNA from blood and amplification of exon 13 and intron 13 of the gene encoding for platelet glycoprotein subunit alphaIIb. Perioperative management consisted of administration of platelet-rich plasma prior to surgery and the use of high-frequency electrocoagulation to minimize tissue trauma. In addition, ovariectomy, rather than ovariohysterectomy, was performed to minimize surgical exposure required and manipulation of the urogenital tract. Results in this dog suggest that a combination of preoperative transfusion with functional platelets and use of techniques to minimize tissue trauma may allow abdominal surgery to be performed successfully in dogs with functional platelet disorders.

Life-threatening hemorrhage from enterotomies and anastomoses in 7 horses

OBJECTIVE

To report our experience with horses that presumptively had severe intraluminal hemorrhage from enterotomy or anastomosis.

STUDY DESIGN

Clinical study.

ANIMALS

Six adult horses and 1 adult donkey.

METHODS

A retrospective study was conducted at the University of Illinois (April 1994 to December 2001) to determine the clinical course and outcome of horses with melena and/or anemia and evidence of life-threatening hemorrhage from intestinal incisions. Medical records of all horses that had colic surgery were reviewed to determine the proportion of horses with this complication. In addition, horses that fit the same criteria identified in 3 other veterinary clinics were included.

RESULTS

Three horses (1.3%) of those that had enterotomy or anastomosis at the University of Illinois and 4 horses from other clinics had complications presumptively related to severe hemorrhage from these intestinal procedures. Melena became evident within 72 hours of surgery and lasted 12 to 96 hours. Six horses had an acute and severe drop in packed cell volume (PCV), increased heart rates, and other signs of acute hemorrhage, and 1 horse had signs of colic postoperatively. Horses were administered intravenous formalin (3 horses) and whole blood transfusions (4 horses). Repeat celiotomy was performed on 2 horses. In 1 of these horses, a bleeding artery was ligated in the edge of the original enterotomy, and, in the other, a 25-cm-diameter intraluminal blood clot was found occluding the pelvic flexure. A horse that had jejunocolostomy for cecal impaction was not treated for hemorrhagic shock but was euthanatized and necropsied. Necropsy revealed blood-filled bowel from the jejunocolostomy to the anus. One of the remaining 6 horses died of enterocolitis and 5 survived to discharge.

CONCLUSIONS

Hemorrhage from incisional edges, particularly in the large intestine, should be considered a rare but possibly fatal complication of enterotomy or anastomosis in horses.

CLINICAL RELEVANCE

To prevent fatal hemorrhage from incisional edges during enterotomy or anastomosis, large vessels should be ligated at the original surgery, and hemostatic effects of different closure techniques should be considered. No intraoperative or postoperative findings were useful to predict this complication, and response to supportive medical therapy was favorable.

Evaluation of ameroid ring constrictors for the management of single extrahepatic portosystemic shunts in cats: 23 cases (1996-2001)

OBJECTIVE

To document the signalment; history; clinical signs; clinicopathologic, diagnostic imaging, and surgical findings; perioperative complications; and long-term clinical results of ameroid ring constrictor (ARC) placement on single extrahepatic portosystemic shunts (PSS) in cats.

DESIGN

Retrospective study.

ANIMALS

23 cats treated with an ARC on a single extrahepatic PSS.

PROCEDURE

An ARC was placed surgically around the PSS. Portal pressure was measured prior to ARC placement, with complete temporary PSS occlusion, and after ARC placement. Cats were scheduled for recheck transcolonic portal scintigraphy 8 to 10 weeks after surgery. Follow-up information was obtained by telephone interview with the owners.

RESULTS

An ARC was successfully placed in 22 of 23 cats. Intraoperative complications, consisting of PSS hemorrhage, occurred in 2 cats. Mean (+/- SD) portal pressure (n = 15) was 6.7+/-2.9 mm Hg before PSS manipulation, 18.6+/-7.7 mm Hg with complete temporary PSS occlusion, and 6.9+/-2.7 mm Hg after ARC placement. Postoperative complications developed in 77% (17 of 22) of cats after ARC placement, and included central blindness, hyperthermia, frantic behavior, and generalized motor seizures. Perioperative mortality rate was 4.3% (1 of 23). Persistent shunting was identified in 8 of 14 cats. Overall, 75% (15 of 20) of cats had an excellent long-term outcome.

CONCLUSIONS AND CLINICAL RELEVANCE

Placement of an ARC on single extrahepatic PSS in cats resulted in low surgical complication and perioperative mortality rates, but most cats did have substantial postoperative complications. Persistent shunting was common, although many cats with persistent shunting were clinically normal.

Correlation between coagulation profile findings and bleeding complications after ultrasound-guided biopsies: 434 cases (1993-1996)

Medical records of 434 consecutive dogs (n=310) and cats (n=124) that received coagulation studies prior to ultrasound-guided biopsy procedures between January 1993 and June 1996 were reviewed for bleeding complications. Minor complications occurred in 21.9% of cases. Major complications occurred in 6% of the cases. Significant bleeding complications were observed in thrombocytopenic cases (P=0.0001). Dogs with a prolonged one-stage prothrombin time (OSPT) (P=0.031) and cats with prolonged activated partial thromboplastin time (aPTT) (P=0.024) were more likely to have complications than patients with normal values. Adequate tissue for histopathological diagnosis was obtained in 96.3% of cases. The likelihood of complication was smaller when the liver was biopsied than when the kidney was biopsied (n=259; P=0.0327). Ultrasound-guided biopsy of intracavitary structures is an effective and relatively safe procedure, but delay of the procedure should be considered when thrombocytopenia is present in the patient.

An evaluation of the haemostatic suture in hysterotomy closure in the mare

This study was designed to evaluate the haemostatic suture as a means of preventing haemorrhage from the hysterotomy in mares after caesarean section. At 2 university hospitals 1982-1994, 48 mares had caesarean section for dystocia, 10 as an elective, and 8 mares concurrently with colic surgery. The haemostatic suture was used in 31 of 66 mares (47%) and surgery period was significantly (P<0.05) shorter when it was not applied. Anaemia (PCV<30%) was recorded in 13 (22%) of 58 mares, excluding the colic group, and the haemostatic suture did not after this proportion of mares that had anaemia. Anaemia was 5 times more probable following caesarean section than vaginal delivery, evidence that bleeding from the hysterotomy is a serious and common complication of caesarean section in mares. Severe uterine haemorrhage was recorded in 3 mares that had an haemostatic suture (10%) and in 2 mares that did not (6%). The latter two mares died of haemorrhage. The suture, therefore did not eliminate post operative anaemia and severe uterine haemorrhage. If omitted, the hysterotomy should be closed with a full thickness pattern that is sufficiently tight to compress vessels in the uterine wall.

Ultrasonographic detection of adrenal gland tumor and ureterolithiasis in a guinea pig

A 5-year-old guinea pig was presented to the University of Berne Small Animal Radiology Department for an ultrasound examination of the abdomen to confirm a suspected diagnosis of Cushing's syndrome. The patient had bilateral alopecia, was apathic and obese. Ultrasonographically, a tumor of the left adrenal gland, obstruction of the left ureter by an ureterolith, as well as hydronephrosis of the left kidney were detected. During surgery to relieve the ureteral obstruction the adrenal gland tumor was removed. The guinea pig died post-operatively due to blood loss. The left adrenal gland tumor was found histopathologically to be an adenoma and the right adrenal gland also had multiple small adenomas, but grossly appeared normal. The ureterolith was analyzed and found by x-ray diffraction to consist of calcium carbonate.

Transportal approach for attenuating intrahepatic portosystemic shunts in dogs

A novel surgical approach, using portal venotomy during total hepatic vascular occlusion, was used to locate and attenuate congenital intrahepatic portosystemic shunts in nine dogs. Shunt location was consistent with a persistent ductus venosus in only two dogs. In the remaining seven dogs the shunts were window-like orifices arising from either the left (two dogs) or right portal vein branch (five dogs) and communicating with the ipsilateral hepatic vein or caudal vena cava. The transportal approach using total hepatic vascular occlusion consistently provided good access to the portosystemic shunts, including those with window-like communications. A 7 to 16 minute period of total vascular occlusion was well-tolerated hemodynamically, with few intraoperative complications. Intrahepatic shunts were successfully attenuated in eight dogs, while one dog with portal atresia was euthanatized. The postoperative course was complicated by high protein pulmonary edema (one dog), an encapsulated biliary pseudocyst (one dog) and uncontrollable hemorrhage caused by an uncharacterized coagulopathy (one dog). Three dogs required a second operation to further attenuate their shunts. The clinical condition of all seven surviving dogs was improved after surgery.

Use of umbilical cord clamps for ovariectomy in cows

Bilateral ovariectomy was performed in 45 beef cows through a left paralumbar fossa laparotomy. Umbilical cord clamps were used to ligate the ovarian pedicle and were found to provide reliable hemostasis. Examination of the uterus by palpation per rectum 10 to 33 days after surgery revealed that the procedure resulted in minimal formation of adhesions, and, in all but 1 cow, the uterine horns were freely movable.